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NPI Code Detail

MEDICARE: DR. MICHELLE ALETA BROADNAX M.D.

MEDICARE: DR. MICHELLE ALETA BROADNAX M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0800XPsychiatry PhysicianMD17992DC

General Provider Information

NPI Number : 1750616645
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHELLE ALETA BROADNAX M.D.
Provider Business Mailing Address
First Line : 9705 POLING TER
Second Line :
City : FORT WASHINGTON
State : MD
Zip : 20744-3970
Country : US
Telephone Number : 301-248-8238
Fax Number :
Provider Business Practice Location Address
First Line : 1313 NEW YORK AVE NW
Second Line : MCCLENDON CENTER
City : WASHINGTON
State : DC
Zip : 20005-4701
Country : US
Telephone Number : 202-737-2316
Fax Number : 202-737-2316
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/09/2009
Last Update Date : 10/09/2009

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